Pediatricians created the peanut allergy epidemic

>Deaths from peanut allergies are real, and living with the problem can be terrifying. Compounding the tragedy is knowing that America’s epidemic of peanut allergies is a largely avoidable consequence of our policy of peanut abstinence.

We keep getting these articles based on 2 peanut studies that specifically only included Jewish children from Israel and England, the ones in Israel had the peanuts early, and the ones in England did not. One study being under 100 children, and one over 1000. Based on these studies Australia changed their recommendations and the number of people introducing their children to peanuts before the age of 1 went from 26% to 85% by 2018. This had _no_ effect on allergy rates to peanuts. They still remain the same.

As an aside, my wife is allergic to peanuts, we have no peanuts in our house, and our kids didn't try peanuts until after the age of 7. None of them have peanut allergies.

I've had a mixed experience with medical professionals and prevailing medical advice. Through my fathers stroke, my mothers heart attack, both of them being diagnosed with some form of diabetes and/or blood pressure just to be prescribed some meds that make it worse (looking at u metropolol) - time and again we have had to filter their advice through common sense and our own experience. Both my parents are managing their lifestyle and diets, and taking smaller or no doses of the meds the docs are prescribing them with glee it seems.

On nut allergies, we have a tradition in India where pregnant and breast feeding women are given every single type of nut over a period of time in a particular sequence. There is something called panjiri that is an amalgam of nuts and ghee, the idea being to provide sustenance to a pregnant mother and then after birth slowly introducing different nuts (and other foods) into the diet over a period of days/weeks. This stuff has been honed over a period of generations.

Nut allergies are fairly uncommon in India. This isn't some silver bullet thing, but just another piece of evidence not to just listen to medical professionals blindly.

Exposure (or lack of) is certainly a huge factor here, but I'm wondering whether some of the variance in peanut allergy between different parts of the world is driven by HLA groups—which are strongly associated with ethnicity and geographic location.

If you got your HLA genes from a great-grandparent who hailed from Scandinavia, are you more likely to develop a peanut allergy than someone whose HLA genes can be traced back to West Africa?

I'm also curious about the way that many (if not most?) kids seem to suffer less severe peanut allergies as they get older, or even grow out of them entirely... because I've heard similar things about bee sting allergies. Not sure if it's a similar mechanism at play.

good summary from the article:

"When modern medicine issues recommendations based on good scientific studies, it shines. Conversely, when doctors rule by opinion and edict, we have an embarrassing track record. Unfortunately, medical dogma may be more prevalent today than in the past because intolerance for different opinions is on the rise, in medicine as throughout society."

Ugh, we're going through the cycle of the author of the book going around spreading his little tidbits in all the main sites/podcasts (I heard him on Econtalk).

For us rest-of-the-worlders - note that Peanut allergy is not an invention - there is a small minority of people with peanut allergies, even after exposure to peanuts as infants. However, there is a larger subset of people who developed peanut allergy in the US through full avoidance of peanuts, so that when later in life they came into contact with them, it started an IgE-mediated cascade (according to the model, on the second exposure to peanuts) that could've been avoided had their body been habituated to peanuts earlier in life.

The real thing to learn here is how suggestions become dogma in human society. "We don't know what's causing allergy, maybe just avoid it?" becomes "We [some formal group of pediatric allergologists] suggest to avoid peanuts" becomes "Our guideline is to avoid peanuts".

The point of Evidence-Based Medicine is exactly to avoid this, but note that this is the standard affairs in anything else in life. Iterative improvement is built on doing something until it stops working/starts harming and then doing something else. It's just magnified where human life is concerned - Military, Aviation, Medicine, etc.

Just like in Aviation - the best solution is process - to admit mistakes and force changes and improvements without knee-jerk opprobrium and litigation (here it's obvious that no medical association should suggest something extreme if there's no evidence for it one way or the other, duh) - but creating sensationalist headlines demonizing a group just makes sure that future mistakes will continue to be covered up.

the facts in the article do not justify the headline. 'early exposure resulted in an 86% reduction in peanut allergies by the time the child reached age 5', it summarizes one study. 'Jewish children in Israel had one-tenth the rate of peanut allergies compared with Jewish children in the U.K.,' it summarizes another. but a 6× or 10× smaller peanut allergy epidemic would still be a peanut allergy epidemic. something else is going on

if no cameroonian children have a peanut allergy, could it be that 0.6% of them are born with a peanut allergy but die undiagnosed in infancy?

Offtopic, but has the WSJ started blocking archive.ph? I see an extra capcha on the cached page.

Pediatric allergy and atopic diseases in general is a mess an only slowly getting better. There's strong correlation between early eczema and food allergies, and now mild but convincing evidence it could even be causal. That eczema (and atopic disease in general) is strongly linked with microbiome and exposure to beneficial bacteria, especially in the first few days and weeks of life. This is also associated with malnutrition, diabetes, obesity, colic, and other symptoms we generally only treat symptomatically and in a silo. Yet for structural reasons, most pediatricians will at best tell you that early probiotics is a placebo. Top pediatricians in the know though will enthusiastically support targeted probiotics. Hell, the whole country of Bangledesh has a successful probiotic program -- https://www.science.org/doi/10.1126/scitranslmed.abk1107. It's amazing how much of common pediatric wisdom in the 80s/90s (clean newborn after birth, eat mushy prepared foods, enriched formula feeding, clean environments, avoid allergens, etc) are now seen as really harmful.

Aside: One issue that you'll come across for allergy tests is that they are pretty much useless. It's been a while, but if I recall correctly, the false positive rate is ~10% and the false negative rate is ~45%. This is for both the skin prick and the IgG (IgE?) tests. If you run those numbers through the standard Bayesian analysis, you'll conclude that you pretty much get no information from these tests.

But, really, go out and make sure they don't have some new test these days and figure out what those false positive and false negative rates are.

Essentially, you're at the mercy of the allergists and the luck here. Make sure to find a good MD for help.

My youngest has been the ER three times due to ingesting peanuts, including once when the local Costco was sampling granola bars that contained peanuts. There was no posted allergy warning.

A couple of minutes after the staff realized what had happened, a Costco employee hastily scribbled a peanut warning sign with a Sharpie and taped it to the sample station.

Another time we had to administer an Epipen at a Mexican restaurant after she ate a cheese enchilada. Turns out their red sauce contained peanut butter.

Our pediatrician strongly encouraged us to introduce nuts young. It was not just about developing finance tolerance, it's that the reaction would be less severe when you are younger and your immune system is less developed.

Also, death from anaphylactic shock is much, much, much rarer than I was led to believe. Only a few dozen cases a year, and the majority had compounding health issue (like asthma or heart problems). The anecdotes about people almost dying are just that.

I'm growing against the idea that we actually have this understood. As someone that presented allergies at the age of several months, it feels somewhat suspicious to think I just needed to be exposed earlier in life.

I am open to the idea that people avoid exposure with more zeal than is needed. A lot of that comes from the desire to be doing something active to protect your kids. Such that it is understandable, even if it could be counter productive.

I am also still heavily disposed to think that there were many other contaminants that we were exposed to than at any other time in history. Trans fats, as my easy example, were terrible and only stopped being used relatively recently. That and second hand smoke. Which, wow.

My anecdote. My wife ate PB&J sandwiches all through pregnancy and when breastfeeding. Still, my son was diagnosed with a peanut allergy as an infant, before he was even old enough to really munch on a Bamba.

Also "We have no peanut allergies in Africa"... come on. Maybe it is less prevalent, but what nonsensical quote to include in an article.

It's my experience that Americans, through peanut butter, also eat more peanuts in general than other cultures. Most other places I've been to only have limited snacking or cooking with peanuts and don't really eat any peanut butter (if it's even available in stores, which it often isn't unless there's an "American Food" section).

I'm not buying this pseudo-scientific nonsense. Allergies have to do with the immune system, but you cannot be "immunized" against an allergy.

Someone genetically predisposed to a peanut allergy cannot have that problem thwarted by early exposure.

Allergies grow worse with exposure, as the substance which triggers the allergy is memorized by the immune system. This is sensitization.

The second problem with the claim is that nobody actually does what the article describes: avoid giving kids peanut butter until they are 3. The modern protocol is that peanut butter is cautiously introduced in a tiny amount to a weaning infant. If that looks okay, they get more until it either looks obvious that they are fine, or else that they are not.

The third problem is that even if people doggedly followed this three year rule, it has not been enough time for that to be imprinted on the human genome, so that we have more prevalence of peanut allergy now in our DNA.

All we have today is better awareness. That's why there is more of everything, not just peanut allergies.

I wonder, do the believers in this hypothesis also think this would work for industrial irritants? If we just expose infants to epoxy resins, they will later able to work in a fiberglass shop without any problems?

anyone got a paywall workaround for this?

Knowing how people in the US are, this article could be published everywhere, on billboards, even tattooed on Doctors foreheads. The damage is done.

Pregnant people and young kids will still avoid peanuts and nuts like the plague, no matter what health officials say. So, this will continue to get worse.